An Update on the Emergence of Glycopeptide Resistance in Enterococci

Glycopeptide resistance may be either constitutive or transferable (on plasmids or as a transposon), and four phenotypes (van A, B, C, D) have been described to date. Recent data suggest solid media screening protocols appear to be insensitive at detecting low levels of carriage, and up to 40% of colonized patients may be falsely glycopeptide-resistant enterococci (GRE) negative. Managing GRE-colonized or -infected patients using contact precautions appears to be useful in controlling clonal outbreaks, but may be of limited utility once GRE is endemic. Alternate strategies to manage GRE-colonized patients with prolonged carriage and in outpatient or home health settings include using risk-based transmission assessment to limit the logistic and psychosocial difficulties associated with the use of continuous contact precautions. The therapeutic options for treating GRE infection remain limited. Attempts to decolonize GRE-colonized patients with bacitracin appear to be of limited utility.